Asthma is a longstanding disorder that affects the airways and impedes the flow of air in and out of the lungs. The disease is characterized by symptoms such as persistent wheezing, difficulties breathing, tightness of the chest, and coughing (Akinbami et al., 2018). Asthma was selected because of the magnitude of its prevalence and impact on the quality of life. Findings of the Global Burden of Disease study (GBD) show that asthma was among the most significant contributors to fatal and non-fatal disease burden as well as the predominant chronic respiratory disease globally in 2015 (GBD 2015 Chronic Respiratory Disease Collaborators, 2017). Approximately 7.5% of grownups in the United States of America are diagnosed with asthma, resulting in about 1.8 million hospitalizations and 10.5 million physician visits annually (McCracken et al., 2017). Akinbami et al. (2018) report that incidence of asthma is higher among Puerto Rican Hispanics than other ethnicities and is estimated to be 12.3%, whereas the second highest incidence documented in blacks (8.7%) followed by whites (7.6%). Additionally, more blacks have been reported to succumb to the disease. This information indicates the influence of ethnicity on asthma.
The above statistics indicate that asthma is prevalent and affects the day-to-day activities of affected individuals. Therefore, there is a need to look into this disease to understand its etiology, treatment, and best practices. The purpose of this paper is to describe the pathophysiology of asthma, the recommended standards of practice, clinical guidelines, and treatment. The paper also describes the managed and unmanaged disease process as well as the cost implications of the disease.
Asthma occurs due to the limitation of the airways, which is attributed to different changes such as bronchoconstriction, airway edema, hyperresponsiveness, and remodeling. An asthma incident, which is also known as an exacerbation or attack, is characterized by wheezing, difficulties breathing, coughing, and shortness of breath. Asthma exacerbations are usually brought about by exposure to precise triggers, which can be classified as sensitizers, irritants, or physical conditions (Yokoyama, 2018). The sequence of events that result in an attack is constant regardless of the trigger.
Bronchoconstriction, which is the contraction of the airways and consequent obstruction of airflow, is the main physiological event that results in the clinical manifestation of asthma. Exposure to irritants or allergens causes the smooth muscles of the bronchioles to contract. Allergens initiate the activation of immunoglobulin E (IgE), which mediates the production of intermediaries such as leukotrienes, histamine, prostaglandins, and tryptase from mast cells (Yokoyama, 2018). These substances act directly on the smooth muscles to elicit contraction. Bronchoconstriction may also arise from intense exercise, extreme cold, and taking no-steroidal anti-inflammatory drugs such as aspirin.
As inflammation intensifies, additional factors such as airway edema, excessive secretion of mucus, and formation of thickened mucus lumps worsen the impedance of air movement. Morphological alterations such as hyperplasia and hypertrophy can also contribute to inflammation. Hyperresponsiveness of the air passages occurs when the bronchoconstrictor response is exaggerated. Factors such as structural modifications, inflammation, and aberrant regulation of the neurons can cause hyperresponsiveness. Airway remodeling refers to the irreversible alterations to the airways due to the gradual loss of lung function (Yokoyama, 2018). Numerous structural cells are activated and cause permanent changes to the airways, which block the flow of air. Remodeling of the airways reduces the patient’s response to medications and complicates the management of the disease.
Sensitizers include high and low molecular weight agents that set off an immunologic reaction that leads to the generation of nitric oxide gas. The latter category consists of substances such as dust, plant proteins, flour, cereals, latex, seafood, and coffee beans among others. The initial exposure to these substances activates the secretion of precise immunoglobulin E antibodies (Yokoyama, 2018). Subsequent contact results in the attachment of these agents to their antibodies, which in turn cross-link with mast cells and activate them to produce inflammatory mediators of asthma. Low-molecular-weight agents, in contrast, consist of dyes, metals, glutaraldehyde, acrylates, and formaldehyde. They often combine with additional proteins to form sensitizing agents. Irritants produce asthma symptoms without allergic reactions. They include substances such as fumes, gases, vapors, and aerosols. Physical conditions that may cause asthma include physical activity or exposure to cold air. These conditions alter the temperatures of the airways and lead to bronchoconstriction.
Asthma begins developing in the early phases of life. However, its expression is a product of multiplex, interactive process that relies on the interchange between host factors and environmental contacts that happen during the development of the immune system. Host factors include genetics, sex, and innate immunity, whereas environmental exposures include allergens, respiratory contagions, and other ecological factors. An imbalance between T-helper (Th) cells 1 and 2 results in inflammation in allergic disorders, including asthma (Tran et al., 2016). This shift is attributed to the overexpression of Th2 or the reduced production of Th1. The role of Th1 is to produce interferon-gamma and interleukin 2, which play a vital role in cellular response machinery following infection. On the contrary, Th2 produces various cytokines such as interleukins 4, 5, 6, 9, and 13 that cause allergic inflammation. The hygiene hypothesis assumes that the immune system of infants is likely to produce Th2 than Th1 (Yokoyama, 2018). Therefore, contact with environmental triggers such as contagions stimulates Th1 responses, resulting in a balance between Th1 and Th2, thereby preventing asthma.
Genetics determines one’s susceptibility to asthma. Having close family members with asthma increases the likelihood of developing the same condition. However, information concerning the precise genes that are involved in the disease is lacking. Nevertheless, genetic variations influence the response to treatment. More boys than girls have asthma in the early developmental stages. However, this balance shifts at puberty, suggesting that sex hormones play a role in the development and persistence of the disorder.
The two most important environmental determinants of asthma are allergens and viral respiratory diseases. The involvement of different allergens has already been illustrated. Respiratory viruses mediate the development of asthma, particularly parainfluenza and respiratory syncytial virus (RSV), which cause bronchiolitis that mimics the symptoms of asthma in infanthood (Lu et al., 2016). Having symptomatic rhinovirus during childhood may also increase the risk of persistent wheezing later on in life. Additional environmental exposures that may cause asthma include air pollution and tobacco smoke. These substances cause the disease through allergic sensitization. Diet, in contrast, influences an individual’s body weight, which may increase predisposition to asthma (Guilleminault et al., 2017). Being overweight promotes inflammatory reactions that cause asthma.
Standard of Practice
Quality asthma care entails accurate diagnosis of the disease and attainment of optimal control on short-term and long-term bases through regular follow-up. The National Heart, Lung, and Blood Institute [NHLBI] (2018) recommends that the following should be done during asthma diagnosis and treatment. The initial visit should involve diagnosing the disease, assessing its severity, initiating treatment and teaching and demonstrating medication use to patients, formulating a written asthma action plan, and slating a follow-up plan. During follow-up visits, the clinician should evaluate and monitor the patient’s control of asthma and check medication compliance and side effects before deciding to make any changes to the regimen. The changes could involve increasing or reducing the type and dosage of medications. The next step is reviewing the asthma action plan and make any changes if need be before reserving the next appointment. Details regarding the precise diagnosis, assessment, and patient education are provided under specific subheadings in the clinical guidelines.
Pharmacotherapy in asthma is determined by the patient’s needs. The goal of pharmacologic treatment is to control long-term and night symptoms, sustain normal levels of activity such as exercise, and preclude acute incidents of asthma attacks. Other goals of treatment are maintaining normal pulmonary function while avoiding the adverse effects of asthma drugs (NHLBI, 2018). Changing from one class of medications to another should follow a sequential course known as the stepwise management of asthma, which is a 6-step process that should be done based on demonstrated efficacy, adherence, and side effects of the medications.
Short-Acting Beta2 Adrenergic Agonists (SABAs)
The short-term relief of asthma symptoms is provided by short-acting beta2 adrenergic agonists (SABAs) such as salbutamol. These drugs work by relaxing the dilating the airways, thereby allowing smooth airflow. They should be used for irregular symptoms or as prophylaxis before exercise. Notable side effects include trembling, headaches, and nervous tension. However, these resolve with the continued use of medication (NHLBI, 2018). Patients should avoid excessive use as it can cause hyperkalemia or heart attacks.
Inhaled Corticosteroids (ICS)
The first-line treatment for asthma is inhaled corticosteroids (ICS), which are to be used for all forms of asthma. They can also be administered alongside SABAs to hasten recovery and prevent the reoccurrence of attacks (NHLBI, 2018). These drugs work by preventing the recruitment of inflammatory cells into the airways thereby preventing inflammatory reactions that cause exacerbations. Common side effects include hoarseness, coughing, or sore throat. Long-term use may cause weight gain and increase the risk of developing pneumonia.
Long-Acting Beta2 Adrenergic Agonists (LABAs)
The second-line treatment consists of long-acting-beta2 adrenergic agonists (LABAs) such as salmeterol and formoterol, which work by bronchodilation. Their effects may persist for 12 hours at low dosages and 24 hours at high dosages. This class of medications is recommended for patients who experience inadequate control of symptoms while using ICS. Adverse effects associated with LABAs include tremors and palpitations (NHLBI, 2018). The long-term use of LABAs as monotherapy is contraindicated. Patients should also avoid using them regularly because they can camouflage poorly controlled asthma.
Other Anti-Inflammatory Inhalers
Other medications used for asthma management include anticholinergics such as tiotropium, which work by blocking muscarinic cholinergic receptors and decrease the vagal tone of air passageways. Anticholinergics work synergistically with SABAs and can also be used as alternatives in patients who report adverse effects with SABAs (NHLBI, 2018). These drugs are associated with adverse effects such as dryness of the mouth, dizziness, bronchitis, urine retention, urinary tract infections, allergic rhinitis, diarrhea, and coughs. Therefore, they are used only when other treatments are not tolerated. Methylxanthines such as theophylline can be used as adjunctive therapy with inhaled corticosteroids. They exert their effects through bronchodilation and are linked to adverse effects such as cardiac arrhythmia, vomiting, and seizures (NHLBI, 2018). Therefore, these drugs are rarely used. The stepwise management of asthma entails the administration of SABAs as needed (step 1), followed by a low-dose ICS (step 2), medium-dose ICS (step 3), medium-dose ICS and LABA (step 4), high-dose ICS and LABA (step 5), and high-dose ICS and LABA or montelukast, in addition to an oral corticosteroid (step 6).
The current organization adheres to the pharmacological guidelines recommended in the standard of practice and uses the stepwise approach in the management of asthma. Patients are advised to use SABAs for immediate relief of symptoms. However, the long-term control of the disease is ensured through combinations of treatments such as LABAs and ICS. During follow-up, side-effects reported by patients are evaluated to determine the need for treatment modification or substitution of drugs.
These treatments have positive effects on asthmatic patients in the community. Treatment is associated with improved outcomes and management of symptoms. For example, the progression of the disease is slowed down, enabling patients to engage in normal activities such as work or school. The prophylactic use of SABAs and LABAs has enabled enthusiastic patients to engage in sports. However, a few cases of noncompliance with treatment have been reported.
The goal of assessment in asthma is to evaluate the control of symptoms, monitor patients’ response to treatment, determine the severity of the disease, and predict the risk of future exacerbations. Assessment is done through spirometry to determine reversibility (NHLBI, 2018) and obstruction. Spirometry is done before and after the initiation of bronchodilator therapy. Peak flow measurements should be taken in patients who have asthma symptoms but have normal spirometry readings, preferably as the first thing in the morning and before sleeping at the end of the day. Peak flow monitoring enables the identification of mild changes to lung function, which could otherwise go undetected. Asthma impairments denote the influence of the disorder on the execution of day-to-day activities and the possibility of future flare-ups. The symptoms of asthma differ in intensity and frequency. Patients should also be assessed based on their exposure to contributing factors such as environmental pollutants, allergens, or modifiable risk factors such as stress, diet, and obesity.
Spirometry readings and impairments are used to classify asthma as intermittent, persistent-mild, persistent-moderate, and persistent-severe (NHLBI, 2018). Intermittent asthma is characterized by the manifestation of symptoms a maximum of twice a week, less than 2 nighttime awakenings per month, normal FEV1 values between flare-ups, predicted FEV1 of at least 80%, and normal FEV1/FVC ratios. Mild asthma is typified by symptom presentation more than twice a week but not every day, nighttime awakening once or twice a month in children below 4 years and 3 to 4 times in older children and adults. The disease poses minor limitations and yields spirometry FEV1 readings of at least 80% and normal FEV1/FVC ratios. Moderate asthma is indicated by the daily presentation of symptoms, nighttime awakening of 3 to 4 times a month in children below 4 years and more than once a week but not daily in older children and adults. The disease poses limitations, causes predicted FEV1 values of between 60 and 80%, and FEV1/FVC of 75 to 80%. In contrast, severe asthma is marked by symptom presentation throughout the day, nighttime awakenings more than once a week in children below 4 years, and every day in older children and adults. The disease causes extreme limitations and FEV1 values below 60% and FEV1/FVC ratios below 75% (NHLBI, 2018). These classifications also influence pharmacological treatment.
The diagnosis of asthma should be based on a thorough medical history, physical examination, and spirometry. The medical history should determine the existence of the classical symptoms of asthma and whether they worsen with exercise, allergens, viral infections, or weather changes. Features that are associated with the presentation of symptoms help to determine patterns of infection and indicate possible triggers that should be avoided. Information concerning family histories of asthma or allergies should also be obtained.
The physical exam should concentrate on the chest, upper respiratory tract, and the skin. It may reveal the use of accessory muscles, thorax hyper-expansion, chest deformity, and the development of hunched shoulders. Normal breathing may contain wheezes or a protracted interval of strained exhalation, which are indications of air blockage. A visual exam of the upper respiratory tract may reveal nasal polyps, inflammation of the mucosa, and augmented secretion of nasal fluids (NHLBI, 2018). Conversely, skin findings may include manifestations of allergic skin reactions such as eczema or atopic dermatitis.
Pulmonary function should be assessed objectively to ascertain asthma diagnoses because the status of lung impairment cannot be exemplified accurately through medical history and physical examination. Furthermore, lung function tests enable the authoritative exclusion of other diagnoses. Spirometry verifies obstruction and evaluates reversibility. However, only patients aged 5 years and older should undergo spirometry. Increases in FEV1 exceeding 12% or more than 10% of predicted FEV1 following the use of a short-acting bronchodilator signify reversibility (NHLBI, 2018). Differential diagnoses should be identified and excluded by performing more diagnostic tests.
Patients should be taught to identify asthma triggers and avoid them through environmental control suggestions. Self-monitoring plays a crucial role in treatment adherence and symptom management. Patients need to be empowered to evaluate the extent of asthma control and be familiar with the signs of worsening disease. Effective asthma control is attained if patients adhere to the medication regimen (NHLBI, 2018). Therefore, proper use of medications and devices should be taught, for instance, inhaler techniques and distinguishing between long-acting and short-acting drugs. ICS are long-term control drugs and should be taken daily because they do not provide immediate relief. Conversely, quick-relief medications such as SABAs alleviate symptoms quickly and are not beneficial for the long-term control of the disease. Healthcare providers such as pharmacists, respiratory therapists, nurses, and asthma educators should be included during education sessions, which should be done and reinforced at all points of care whenever possible.
A written action plan should be developed by clinicians together with the patient and caregivers. Precise short-term and long-term treatment goals should be established and supported by the three parties (NHLBI, 2018). The asthma action plan should contain information to guide patients about daily actions to manage the disease, medication adjustment based on the presenting symptoms, and when to seek medical attention. Treatment plans that achieve optimal disease control and consider the patient’s preferences should be selected. Patients should be encouraged to observe the endorsements of the action plan, which should be reviewed at each visit and adjusted based on noted concerns. Patients who report optimal disease control should be commended to boost their confidence and improve adherence. Comorbid conditions such as rhinitis, aspergillosis, obesity, sinusitis, and obstructive sleep apnea should also be treated.
Standard Practice of Disease Management
The standard procedures in diagnosis, assessment, pharmacological treatment, patient education, and follow-up in the candidate’s community align with those stipulated in the national guidelines. Spirometry results together with patients’ history, physical exam findings, and symptoms are used to establish asthma diagnoses (NHLBI, 2018). Pharmacological treatment follows the stepwise approach endorsed by the clinical guidelines. Patients are taught the identification and avoidance of triggers, the use of specific medications such as inhalers, and warning symptoms. This information is summarized in asthma action plans that are reviewed during follow-up visits. Slight differences, however, exist in the non-pharmacological interventions. The national guidelines do not include exercise recommendations in nonpharmacological interventions, whereas the health facilities in the candidate’s community advise patients regarding suitable exercises to engage in, for instance, swimming.
Managed Disease Characteristics and Resources
The three vital components that lead to a well-managed disease process are the identification and avoidance of triggers, adherence to treatment recommendations, and timely access to medical attention during flare-ups. Resources required include financial means to afford treatment and access to well-equipped hospitals. The life expectancy in managed asthma does not differ from that of healthy individuals without the disease (Bayes & Thomson, 2016). However, unmanaged asthma may reduce the life expectancy, though precise numbers are unavailable because numerous factors (such as age and comorbid conditions) contribute to overall life expectancy.
The standards of practice for asthma diagnosis and management in the UK are similar to the US. A stepwise approach to treatment is followed, for instance, the use of SABAs only for immediate relief of symptoms. ICS is the first-line treatment, whereas LABAs are used as second-line treatment (NICE, 2020). The guidelines require the consideration of factors such as treatment adherence, alternate diagnoses, lifestyle choices, and occupational exposures before treatment modification. Similar treatment and guidelines are applied in Australia as well (National Asthma Council, 2020). Noted disparities include prolonged use of oral corticosteroids in the US compared to Australia and the UK. The national (US) guidelines recommend spirometry in asthma diagnosis for children aged 5 years and above, whereas Australia endorses spirometry in children aged 6 years and older.
Managed Disease Factors
The adequate management of asthma depends on patients’ ability to identify and avoid triggers, adhere to medications, monitor the symptoms of exacerbations, and execute the right procedures during attacks. Exposure to allergens sets off the inflammatory reactions that lead to the constriction of airways (Tomisa et al., 2019). Therefore, having prior knowledge of triggers that elicit such reactions enables an asthmatic patient to avoid them, thereby minimizing the likelihood of attacks. Adherence to medications facilitates the control of symptoms and prevents the recurrence of symptoms. Optimum treatment controls inflammation as well as the narrowing airways. Additionally, monitoring the asthma symptoms enables one to determine whether the situation is deteriorating and the need to seek medical attention. Asthma exacerbations are usually managed through the administration of SABAs to hasten bronchodilation and restoration of lung function. Knowledge of the right medications to use at different disease stages contributes to managed asthma.
Patients would need resources such as access to care, health literacy, the financial capacity to afford treatment, and a stable support system. Asthmatic patients should be able to access urgent medical care without unnecessary delays, which may be caused by poor infrastructure or transport systems. Health literacy empowers a patient to understand the disease course, causes, and preventive measures (Tomisa et al., 2019). Socioeconomic status influences the financial capacity to afford treatment either through health insurance covers or out-of-pocket payments. Managing asthma requires several changes in one’s surroundings, such as thorough cleanliness to avoid triggers such as dust and staying away from pets. A supportive family is important to facilitate the avoidance of triggers and promote medication adherence.
Unmanaged Disease Factors
Factors that contribute to unmanaged asthma include poor management of triggers and allergens, non-adherence to medications, poor monitoring of the symptoms of exacerbations, and incorrect treatment of flare-ups. Constant exposure to triggers knowingly or unknowingly results in inflammatory reactions that yield the symptoms of asthma. Noncompliance with treatment recommendations leads to poor control of symptoms and frequent exacerbations due to uncontrolled inflammation and narrowing of the airways. The inability to look out for the indications of attacks prevents the implementation of prophylaxis measures or seeking medical assistance promptly. Using incorrect medications hampers the ineffective management of symptoms. For example, using LABAs without ICS may cause life-threatening attacks (Rodrigo et al., 2017). Therefore, LABA monotherapy is contraindicated in asthma.
Poor access to care limits timely treatments and leads to unmanaged disease. Low socioeconomic standing results in the inability to afford asthma medications and treatment, leading to poor control of symptoms (Tomisa et al., 2019). In contrast, the lack of a supportive family may contribute to poorly managed asthma through continued exposure to allergens or the lack of encouragement to adhere to medications, particularly in children and adolescents.
Unmanaged Disease Characteristics
Characteristics of unmanaged asthma include the daily occurrence of asthma symptoms, the need for frequent use of quick-relief medications, night-time attacks, and frequent visits to the emergency room. Patient behaviors that may contribute to the uncontrolled disease include non-adherence to medications, active or passive smoking, the presence of comorbid diseases, and occupational exposures to triggers. Psychosocial factors such as stress can also contribute to unmanaged asthma.
Patients, Families, and Populations
Burden to Patient
Asthma is a lifelong disorder that increases the risk of developing Chronic Obstructive Pulmonary Disease (COPD). Therefore, it is a major burden that affects the quality of living as measured by disability-adjusted life years (DALYs). The ailment accounts for approximately 1.1% of the global estimation of DALYs per 100,000 for all causes (Ferrante & La Grutta, 2018). At the candidate’s community, asthma affects the day-to-day activities of affected patients such as attending school and work. Asthma interferes with the performance of physical activities such as sports and limits the range of leisure activities of patients (Ferrante & La Grutta, 2018). Most asthmatic children miss about 3 to 5 days a week because of exacerbations. Working adults with asthma often request for time off for emergencies or hospital appointments.
Burden to Family
At the candidate’s community, parents or families of children with asthma may miss approximately 3 to 5 working days when taking care of children with exacerbations. Given that asthma triggers play a crucial role in the development of asthma symptoms, such families are compelled to make necessary adjustments to avoid all known triggers (Ferrante & La Grutta, 2018). For example, families have to forfeit pets, observe extremely high standards of hygiene, and make other adjustments to their daily living.
Burden to Community
At the candidate’s community, asthma is associated with loss of productivity, which ultimately affects the economic status of afflicted patients and their families. Furthermore, patients with asthma require constant medical attention, which may be hampered by poor access to health care services. In the current community, there are well-equipped private and public health care facilities. However, not all patients with asthma can afford to obtain timely treatment or avoid triggers due to low socio-economic status that compels them to overlook certain risks in a quest to earn a living.
The costs associated with asthma can be categorized as direct, indirect, or intangible costs. Direct costs comprise between 50 and 80% of the total costs and go towards the expenses incurred during the management of the disease such as normal outpatient visits, emergency room visits, drugs, and hospital admissions (Nunes et al., 2017; Ferrante & La Grutta, 2018). Complementary treatment costs such as home care consultations, transport to and from health facilities may also be incurred. Children and teenagers with asthma have more outpatient and emergency room visits than non-asthmatics. The costs associated with such care is proportional to the severity of the disease. Additionally, children are two times more likely to be hospitalized than adults, especially those below 5 years of age. The cost of medications differs from one country to another based on insurance coverage or prevailing health systems. For instance, the average cost of treatment in the US is $3,100, whereas in Europe a patient spends about $1,900 annually (Nunes et al., 2017). The use of inhaled steroids is associated with higher treatment costs. Uninsured patients are forced to make out-of-pocket payments, whereas those with insurance may be required to pay additional premiums.
The direct patient costs of asthma patients also apply to their families, particularly for pediatric populations. However, for independent adult patients, these costs may not affect their families directly. Nevertheless, such families are affected indirectly in terms of limited disposable incomes, additional caregiver responsibilities, and home revisions or accommodations to ensure that it is safe for the patient. The overall effect of all these costs is a reduction in household income.
The community costs of asthma include the direct expenses incurred by the healthcare system in managing the condition as well as missed school or working days and premature mortality. The US economy spends or loses more than 80 million dollars annually on the treatment and productivity losses associated with the disease (Ferrante & La Grutta, 2018). Communities should also ensure that the human resource required to keep ailments under control, including physicians, paramedics, educators, and nurses should be readily available. Hospitals should also have the necessary equipment for treatment (imaging, lung function tests) and rehabilitation. Therefore, the state has been compelled to recruit asthma educators and support outreach and education programs in addition to funding the equipping of public health facilities with appropriate equipment.
Best Practices Promotion
There are no significant deviations between the standard of practice to the normal practices at the candidate’s facility or state. However, certain aspects of disease management practices could be improved to reduce the incidence of non-adherence, particularly patient education and follow-up. For example, patient education only takes place once and does not include different healthcare providers. Furthermore, the action plans are not reviewed as frequently as they should during follow-up visits. Goals for improvement include reducing emergency room visits due to asthma exacerbations, reducing treatment non-adherence, and improving patients’ knowledge of asthma control.
The first strategy is implementing patient education at each stage of treatment. Evidence shows that patient education improves knowledge levels and enhances overall treatment outcomes (Ehteshami-Afshar & FitzGerald, 2017; Murray & O’Neill, 2018). The hospital would ensure that patients are educated about asthma management as they receive their medications as well as before being discharged from the facility. The second strategy is initiating home peak flow measurements for all asthma patients. Peak flow monitoring is a simple and affordable way of detecting airway obstruction, thereby helping patients to monitor their symptoms (Thorat et al., 2017). Patients would be taught to obtain and interpret their peak flow measurements at home and report any abnormalities. The third strategy is administering an asthma self-assessment form to patients during each hospital visit. Self-assessment through questionnaires such as the Asthma Control Test (ACT) can reveal treat deficiencies among patients and enable timely intervention (Alzahrani & Becker, 2016; Barbara et al., 2020). The findings from these interventions would inform clinicians about the next course of action.
The impact of education will be evaluated by gauging patients’ knowledge levels using a validated self-administered questionnaire that will be administered before and after the intervention. The impact of home peak-flow monitoring will be determined by comparing the incidence of emergency room visits due to asthma symptoms before and after the intermediation. The self-assessment scores from the ACT questionnaire will be obtained before and after the education intervention and used to identify areas for further teaching (Alzahrani & Becker, 2016). Specific findings from each strategy will determine the achievement of the overall goals for improvement.
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